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e'zV-d t.'0? <br /> Burnett County Office of Zoning Administrator 0 0 <br /> APPLICATION FOR SANITARY — LAND USE — BUILDING PERMIT d 3. <br /> o <br /> TO THE ZONING ADMINISTRATOR: The undersigned hereby makes application for a Permit for the work described and located as H <br /> shown herein. The undersigned agrees that all work shall be done in accordance with the requirements of the Burnett County Land Use m C <br /> Ordinance, Sanitation Code, and with all other applicable County Ordinances and the laws and regulations of the State of Wisconsin. 3 a <br /> Donald E. Lemire self H <br /> ........................................... ............................................................................................ 0 <br /> 0 <br /> j <br /> OWNER (please print) Ct7NTR ACTOR or SURVEYOR or AGENT � m <br /> 2604 Xenwood Ave. So. <br /> ADDRESS ADDRESS <br /> St. Louis Park, Minnesota 55416 <br /> ADDRESS............................................................................ .ADDRESS............................................................................ , <br /> (612) 925-1206 <br /> .......... <br /> ................................................................................ .P..HONE............................................................................... <br /> PHONE <br /> ......................... ........... .. . .... .................................... ............................................................................................ <br /> ... . .. .... <br /> PLUMBER WELLDRI LLER i \ i <br /> k \; <br /> 93�� <br /> ADDRESS............................................................................ DR <br /> .ADESS....................... ...... <br /> ....... <br /> .............. <br /> ........................... .. o .0 <br /> PHONE PHONE � <br /> Z r <br /> DESCRIPTION 4. Sanitary Facilities: ° o <br /> 1. Work: 2. New Building Details No. Bathrooms .......... \>? o <br /> """"" <br /> Bedrooms i <br /> New Building ,,....,... Type of Construction: No. Be <br /> Addition .,x•••,• F.rame.............................. ........ Septic Tank Size Gals. .......... <br /> Sanitary ,,........ Size .......8..... ft. x ....15...... ft. .......... . <br /> Filling/Grading ,,........ Height............. Stories ............... 4a. Absorption Field Site: <br /> Moving .......... Area ...120..5.5 ft................. Soil Type .................................... r <br /> Mobile HomeSlope ...........................I.............. G <br /> 0 <br /> .......... <br /> Privy .......... 3. Use (describe exactly, 1 -family Pere. Rate ................................... <br /> Well .......... home,garage, motel, etc.) Dry Well .......... i p <br /> Subdivision ....,...., screen porch Seepage Trench .......... <br /> Camping Unit Privy .......... .(_t, <br /> .......... .................................................... SG <br /> Seepage Bed ..........------------------------ <br /> U. <br /> i <br /> Location of proposed structures and existing structures, well, sewage systems, roads, etc., should be sketched in Fig. A. Include road I Q <br /> setback, side and back yard dimension and location and setback from all bodies of water. If property Is located at a highway inter- ea io- <br /> section, show the Intersecting highways and the setbacks required along them and at the Intersection. CLEARLY LABEL EXISTING <br /> STRUCTURES AND PROPOSED STRUCTURES AND ADDITIONS. Ui o <br /> ------------------------------------------------------- <br /> 5. Lot Size: Fig. A. 6. Location: C <br /> 5�....... ft. x ....4!�0+ ft. — ..22.,9.29............... sq.ft. LL.Is..Lot..S. ...Plat...Of...Shady..Gfexr.......... p '• <br /> X' P <br /> j Ilk <br /> m <br /> n <br /> y o 0 <br /> AJ w <br /> 'Y o <br /> O} ` N <br /> s <br /> Z <br /> o <br /> Do (n r Z <br /> nIseQ < m ? F <br /> C <br /> Na n c = o <br /> tNJi <br /> m <br /> z oo n5 70 <br /> 0 o n 3 <br /> 4f _— <br /> :�0 <br /> Aril 23 1985 �� C <br /> /nt <br /> P _........ ..................................Signature of Owner or A Date <br /> X <br /> „ m <br /> Remarks ......................................................................................................................................................................... m � <br /> m : <br /> of <br /> ........................................................................................................................................................................................ .� <br /> :O <br /> ........................................................................................................... ... ..........�.. ........................................... 1C . . . . . . T <br /> Inspection Date ....................................... .....( '..�... ....9........ ................................... 'ro^ — m o m <br /> to o o a <br /> Zonin A Inistrator 8 8 8 8 8 CA <br /> NOTE: A preliminary site inspection must be made a d site approval granted on all structures Involving sanitary facilities <br /> before construction can begin. In the case of sewerage disposal systems, a copy of the percolation test must be attached to <br /> this application before a permit will be issued. Do not purchase or install a septic tank, do any plumbing or start any build- <br /> ing until a permit has been Issued. A permit may be revoked if misrepresentation of any of the information conveyed here- <br /> with is found to exist. Changes in plans or specifications shall not he made without approval of the Zoning Adm inistratol . <br /> SEWER SYSTEM SHALL NOT BE COVERED UNTIL INSPECTED BY THIS OFFICE AND APPROVED. <br />